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General NPI Number Information
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NPI Number | 1831463728
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Entity Type | Organization
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Legal Business Name | GREATER NILES CHIROPRACTIC HEALTH CENTER INCORPORATED
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 2407 YANKEE ST
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City | NILES
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State | MI
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Zip | 49120-3955
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Country | US
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Telephone | 269-683-8151
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Fax | 269-683-6112
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Provider Business Mailing Address
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Address Line | 2407 YANKEE ST
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City | NILES
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State | MI
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Zip | 49120-3955
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Country | US
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Telephone | 269-683-8151
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Fax | 269-683-6112
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Authorized Official
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Title or Position | CHIROPRACTOR/PRESIDENT
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Name | DR. JEFFREY DAVID BOLTON
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Credential | D.C.
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Telephone | 269-683-8151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 23010006540
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License Number State | MI
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